Statins ‘may go to 40% of adults’

Two in every five adults in England could be offered statins to prevent heart attacks and strokes after health officials lowered the threshold for eligible people.

Millions more people will qualify for the cholesterol-reducing drugs on the NHS following updated guidance from the National Institute for Health and Care Excellence (Nice).

Experts said that potentially 17 million people could now be offered the drugs to prevent illness – or around 40% of the adult population in England.

The drugs are currently offered to people in the UK who have a 20% risk of developing cardiovascular disease within 10 years. But new updated guidance from Nice has called for the NHS to widen this to cover people with just a 10% risk.

This lower threshold could see an additional 4.5 million offered the drugs, bringing the total of all eligible people to 17 million, Nice said.

If everyone eligible took the drugs between 20,000 and 50,000 deaths could be prevented every year, a spokesman said.

Experts at the health authority looked at the average blood pressure and cholesterol levels of English adults and found that the average man over the age of 60 would now qualify to take the preventative medication and the average woman over the age of 65 would become eligible.

When the draft guideline was issued earlier this year, a group of leading doctors criticised the plans claiming that the latest guidance is based almost entirely on studies funded by the pharmaceutical industry.

The signatories, including the president of the Royal College of Physicians, also said there were a number of side effects including fatigue, psychiatric symptoms and erectile dysfunction and an increased risk of developing diabetes in middle aged women taking statins.

They also claimed that the “medicalisation of millions of healthy individuals” is unjustified.

But launching the guidance on the prevention of cardiovascular disease, Professor Mark Baker, director of the Centre for Clinical Practice at Nice, said it was “ludicrous” to suggest the move would lead to the over medicalisation of the population

“I must remind you that nobody gets onto our guideline groups if they have any significant vested interest, especially a financial interest,” he said. “No-one was appointed to our group who had anything to gain from the content of the guidance.

“Statins are safe and effective and now they are cheaper it is a good deal for more people to have access to them under the NHS. Doctors have been giving statins to ‘well people’ since Nice first produced guidance on this in 2006.

“We are now recommending the threshold is reduced further. The overwhelming body of evidence supports their use, even in people at low risk of cardiovascular disease. The effectiveness of these medicines is now well proven and their cost has fallen.

“There is a debate going on in the medical press about medicalising the normal person – giving drugs to people who are well and there are some leading clinicians who have questioned whether this is good practice, they are probably the same people who would shout that prevention is better than cure, this guideline is about prevention and it is better than cure.

“It is ludicrous to suggest that we are over-medicalising the population when the whole point of using modern safe and effective drugs in an economic way is to prevent bad things happening in the future.

“I am happy to have the debate with them, I have happy to actively promote our guidance as a very good way of spending NHS resources. I get annoyed when people misrepresent the facts selectively for their own purposes.

“I would say that there is a risk that he noise distorts the message to the point where people whose lives are going to be saved by statins come off them because they don’t understand the confusion created by a tiny minority of doctors who write letters to the press or to the Secretary of State or to us. I think that is a potential tragedy.

“It’s not for me to name names or accuse people of doing individual things but from a public health point of view it is a tragedy waiting to happen and it is really annoying.”

The new guideline recommends that the people who are deemed to have a 10% risk should be encouraged to make changes in their life style, such as stopping smoking, reducing alcohol consumption, eating well and taking part in regular exercise, followed by managing risk factors such as blood pressure and if people are still deemed to be at risk after these actions, they should then be offered statins.

Statins are the most commonly prescribed group of drugs in the health service and based on current prescription levels Nice estimates that up to 10 million people in England are taking the drugs.

The latest figures from the Health and Social Care Information Centre (HSCIC) show that in 2013 there were 66.8 million statins and other drugs that lower cholesterol dispensed in communities across England. T he figure has almost trebled since 2003 when just 22.7 million of these drugs were dished out.

Commenting on the new guidance Professor Peter Weissberg, medical director at the British Heart Foundation, said: “Too many people die from cardiovascular disease, and these new guidelines are part of continuing efforts to prevent heart attacks and strokes.

“Doctors will now be able to offer a statin to people at a lower risk, but their prescription is not mandated. Just as important is the emphasis on trying lifestyle changes before considering treatments with drugs.

“Crucially, the guidelines emphasise that preventive strategies should be based on each individual’s risk and needs with a personalised game-plan to help reduce their risk of cardiovascular disease.”

Professor Sir Michael Marmot, director of the Institute of Health Equity at University College London, said: “Any intervention that reduces risk of disease and prolongs lives is to be welcomed. That said, we should not simply use pharmaceuticals to treat the results of unhealthy conditions. We have to address the root causes of cardiovascular disease.”

Professor Sir John Tooke, president of the Academy of Medical Sciences, added: “The benefits of a healthy lifestyle should be promoted for people at risk of cardiovascular disease, and facilitated by appropriate public health measures.

“Whether or not someone takes drugs to diminish their risk is a matter of personal choice, but it must be informed by accurate information on the balance of risk and benefit in their particular case.

“The weight of evidence suggests statins are effective, affordable and have an acceptable risk benefit profile. Appropriate drug therapy should not be denied on the basis of an ideological stance against ‘medicalisation’.”

Cardiovascular disease cases one in three deaths in the UK, killing around 180,000 every year.

But the British Medical Association (BMA) said it was concerned about the threshold being lowered.

Dr Chaand Nagpaul, chair of the BMA’s General Practitioner’s Committee, said: “While the majority of Nice’s guidance is useful we continue to have concerns over the recommendation to reduce the threshold for the use of Statins in patients with a low risk of cardiovascular disease.

“In making their decision Nice have failed to take the current pressures on general practice into account, and the further impact this will have on already overstretched GPs and those patients, especially older patients, requiring treatment for other illnesses.”